Solving double potential problem

Abstract

The invention is entitled "Solving double potential problems." The invention discloses a method for electrophysiological assessment, the method comprising acquiring electrical signals from a location of a region of ablated tissue in a chamber of a heart, and deriving corresponding annotations from the signals, the annotations indicating times at which a conduction wave traverses the location within a cardiac cycle. The method comprises identifying a first location at a first distance from the region at which the electrical signals include a double potential signal having a first annotation and a second annotation at different times within the cardiac cycle, and identifying a second location near the first location at a second distance from the region, the second distance being greater than the first distance, at which the electrical signals have a third annotation. The method further comprises selecting one of the first annotation and the second annotation that is closest to the third annotation as a valid annotation for the first location, and displaying the valid annotation on an electroanatomical map of the heart.

Description

TECHNICAL FIELD

[0001] The present invention relates generally to invasive medical procedures, and in particular to analyzing the results of cardiac invasive procedures. BACKGROUND

[0002] Invasive cardiac procedures typically include the acquisition of intracardiac (IC) electrocardiogram (ECG) signals, and analysis of these signals. Analysis of IC ECG signals is well known in the art.

[0003] For example, U.S. Patent 10,314,542 to Bar-Tal et al. describes a system for determining a region of interest for cardiac ablation using segmentation. The method can include detecting electrocardiogram (ECG) signals via sensors, each ECG signal detected via one of the sensors and indicative of electrical activity of a heart. The system also includes determining a region of interest for cardiac ablation from the segmentation.

[0004] U.S. Patent Application 2018 / 0235495 to Rubenstein describes a cardiac mapping catheter and methods of using the catheter. The catheter can detect the presence, direction, and / or origin of a depolarization wavefront associated with a cardiac arrhythmia.

[0005] U.S. Patent 10,335,052 to El Haddad describes an apparatus for analyzing electrophysiological data. The apparatus uses a processing apparatus adapted to perform a stepwise analysis of the electrophysiological data to generate a signal indicative of the presence of a pulmonary vein potential component.

[0006] U.S. Patent 6,236,883 to Ciaccio et al. describes a method including the step of identifying and localizing reentry circuits from electrogram features using a feature detection and localization (FDL) algorithm.

[0007] U.S. Patent Application 2017 / 0079539 to Chauhan et al. describes a system for identifying locations of focal sources of electrophysiological activity in an organ. The system can also be used to guide catheter ablation of the organ. SUMMARY

[0008] One exemplary embodiment of the present invention provides a method for electrophysiological assessment, the method comprising:

[0009] acquiring electrical signals from myocardial tissue at a plurality of locations in the vicinity of a region of ablated tissue in a chamber of a heart;

[0010] deriving, from the electrical signals, respective annotations indicative of times at which a conduction wave in the myocardial tissue traversed the locations within a cycle of the heart;

[0011] identifying a first location at a first distance from the region of ablated tissue at which the electrical signal comprises a double potential signal having a first annotation and a second annotation at different respective times within a cycle of the heart;

[0012] identifying a second location near the first location at a second distance from the region of ablated tissue, the second distance being greater than the first distance, at which the electrical signal has a third annotation;

[0013] selecting as a valid annotation for the first location the one of the first and second annotations that is closest to the third annotation; and

[0014] displaying the valid annotation on an electroanatomical map of the heart.

[0015] In one exemplary embodiment disclosed herein, the electrical signal at the second location comprises a single potential signal or a double potential signal.

[0016] In another exemplary embodiment disclosed herein, the chamber comprises an atrium of the heart.

[0017] In another exemplary embodiment disclosed herein, the chamber comprises a ventricle of the heart.

[0018] In another exemplary embodiment disclosed herein, the region of ablated tissue comprises one or more discrete points. Alternatively or additionally, the region of ablated tissue comprises a line segment.

[0019] In one alternative exemplary embodiment, displaying the valid annotation on the electroanatomical map comprises deriving a local activation time (LAT) of the first location from the valid annotation, and incorporating the LAT into the map.

[0020] In another alternative exemplary embodiment, the first location is within a preset threshold distance from the region of ablated tissue. The preset threshold distance can be 10 mm.

[0021] According to one exemplary embodiment of the present application, there is also provided a device for electrophysiological assessment, the device comprising:

[0022] a display configured to present an electroanatomical map of the heart;

[0023] a probe configured to acquire electrical signals from myocardial tissue at a plurality of locations near a region of ablated tissue in a chamber of the heart; and

[0024] a processor configured to:

[0025] derive respective annotations from the electrical signals, the annotations being indicative of times at which a conduction wave in the myocardial tissue traverses the locations within a cycle of the heart,

[0026] identifying a first location at a first distance from the region of ablated tissue at which the electrical signal comprises a double potential signal having a first annotation and a second annotation at different respective times within a cycle of the heart,

[0027] identifying a second location near the first location at a second distance from the region of ablated tissue, the second distance being greater than the first distance, at which the electrical signal has a third annotation,

[0028] selecting as a valid annotation for the first location the one of the first annotation and the second annotation that is closest to the third annotation, and

[0029] displaying the valid annotation on an electroanatomical map of the heart. BRIEF DESCRIPTION OF DRAWINGS

[0030] The present application will be more fully understood from the following detailed description of the exemplary embodiments thereof, taken together with the drawings in which:

[0031] Figure 1 is a schematic diagram of a double potential analysis system according to an exemplary embodiment of the present application;

[0032] Figure 2 is a schematic diagram of a distal end of a catheter for use in the system according to an exemplary embodiment of the present application;

[0033] Figure 3 shows an example of an intracardiac electrogram signal according to an exemplary embodiment of the present application;

[0034] Figure 4A is a schematic diagram of an electroanatomical map of a segment of cardiac chamber tissue according to an exemplary embodiment of the present application;

[0035] Figure 4B is a schematic diagram of a map of a segment of cardiac chamber tissue after an ablation has been performed according to an exemplary embodiment of the present application; and

[0036] Figure 5 is a flowchart of steps of an algorithm performed by a processor of the system according to an exemplary embodiment of the present application. DETAILED DESCRIPTION

[0037] SUMMARY

[0038] If a segment of heart tissue has been ablated (typically along an ablation line), there is a high probability that a double potential will occur at a location near the ablation, i.e., rather than a signal with one annotation, the signal has two annotations. Only one of the two annotations indicates the time at which a conduction wave traversed the given location, but the system processor can select the wrong one.

[0039] In an exemplary embodiment of the invention, the system processor knows the location of the ablation region. For points near the ablation region, and where a double potential occurs, the processor uses this knowledge to select the one of the double potential annotations that is presumed to be the correct one. The selected annotation is the one that is more temporally proximate to the annotation for a neighboring point that is further away from the ablation region.

[0040] Thus, in an exemplary embodiment of the invention, electrical signals are acquired from heart muscle tissue at a plurality of locations near a region of ablated tissue in a chamber of a heart. Corresponding annotations are derived from the electrical signals, the annotations indicating times at which conduction waves traversed the locations in the heart muscle tissue during a cycle of the heart.

[0041] A first location is identified at a first distance from the region of ablated tissue, the first location being a location at which the electrical signal comprises a double potential signal having a first annotation and a second annotation at different respective times during the cycle of the heart.

[0042] A second location is identified near the first location and at a second distance from the region of ablated tissue, the second distance being greater than the first distance. The second location has an electrical signal having a third annotation.

[0043] The one of the first and second annotations that is closest to the third annotation is selected as a valid annotation for the first location. The valid annotation is then displayed on an electroanatomical map of the heart.

[0044] System Description

[0045] In the following description, like reference characters designate like elements and components in the figures and like elements are identified, where desired, by appending the same letter after the element number.

[0046] Referring now to Figure 1 which is a schematic diagram of a double potential analysis system 20, and to Figure 2FIG. 1 is a schematic diagram of a system 20 for use in a medical procedure, in accordance with an embodiment of the present application. The system 20 is used in a medical procedure to map the electrical activity of a patient's heart 34. The system 20 includes a catheter 24, which is inserted into the patient's body and advanced to a chamber of the heart 34. The system 20 also includes an electromagnetic tracking system 23 and a current-based tracking system 21. The system 20 also includes an ablation module 39, which is used to ablate tissue in the chamber of the heart 34. The system 20 also includes an ECG module 43, which is used to monitor the electrical activity of the heart 34. The system 20 also includes a processor 40, which is used to control the operation of the system 20. The system 20 also includes a display 48, which is used to present information to an operator of the system 20.

[0047] The system 20 can be controlled by a system processor 40, which includes a processing unit (PU) 42 that is in communication with the electromagnetic tracking module 36 and / or the current tracking module 37. The PU 42 is also in communication with the ablation module 39 and an ECG (electrocardiogram) module 43. The functions of these modules are described in greater detail below. The PU 42 is also in communication with a memory 44. The processor 40 is typically mounted in a console 46, which includes an operator control 38, typically including a pointing device such as a mouse or trackball, which is used by the operator 22 to interact with the processor. The processor operates the system 20 using software stored in the memory 44. The results of the operations performed by the processor 40 are presented to the operator on a display 48. The results, typically in the form of an electroanatomical map 49 of the heart 34, enable the operator to form an electrophysiological assessment of the heart. The software can be downloaded to the processor 40, for example, in electronic form over a network, or, alternatively or additionally, the software can be provided and / or stored on a non-transitory tangible medium such as a magnetic, optical or electronic memory.

[0048] To track the path of the probe 32 in the mapped region 30, which contains the heart 34, the exemplary embodiment of the present application uses at least one of a current-based tracking system 21 and an electromagnetic-based tracking system 23. Both of these systems are described below.

[0049] The tracking system 21 includes a current measurement tracking system similar to that described in U.S. Patent 8,456,182 to Bar-Tal et al., the disclosure of which is incorporated herein by reference. The current measurement tracking system is manufactured by Biosense-Webster (33 Technology Drive, Irvine, CA 92618 USA) under the trade name CARTO®. The CARTO® system includes a catheter 24, which is inserted into the patient's body and advanced to a chamber of the heart 34. The CARTO® system also includes an electromagnetic tracking system 23 and a current-based tracking system 21. The CARTO® system also includes an ablation module 39, which is used to ablate tissue in the chamber of the heart 34. The CARTO® system also includes an ECG module 43, which is used to monitor the electrical activity of the heart 34. The CARTO® system also includes a processor 40, which is used to control the operation of the CARTO® system. The CARTO® system also includes a display 48, which is used to present information to an operator of the CARTO® system. The system also uses a current measurement tracking system. The current measurement tracking system is under the control of the current tracking module 37. The probe 32 has one or more probe electrodes 50 (assumed herein by way of example to include electrode 50A and electrode 50B), and in the tracking system 21, the module 37 injects a current into the tracked one or more electrodes 50. The current is received by a plurality of substantially similar patch electrodes 77 (also referred to herein as patches) positioned on the skin of the patient 28, and transmitted back to the module.

[0050] Although conductive cables of the patch electrodes 77 and other skin electrodes described herein exist for each of the electrodes, for the sake of clarity, only the cables of some of the electrodes are shown in the figures. The current between a given probe electrode 50 and a skin patch 77 varies depending on the location of the electrode, due inter alia to the different distances of the electrodes from the patches, which result in different impedances between a given probe electrode and different patches. The module 37 measures the different currents received by different patches 77 on respective channels connected to the patches, and can be configured to generate from the different currents an indication of the location of the given probe electrode.

[0051] The electromagnetic tracking system 23 is similar to the one described in U.S. Patent 6,690,963 to Ben-Haim et al. (the disclosure of which is incorporated herein by reference) and the Carto® system manufactured by Biosense-Webster TM The system used in the system. The electromagnetic tracking system is under the control of the electromagnetic tracking module 36. The electromagnetic tracking system includes a plurality of magnetic field generators, which are assumed herein to include three sets of generators 66, each set including three orthogonal coils, so that the plurality of generators includes a total of nine coils. The generators 66 are placed at known locations under the patient 28, which define a frame of reference of the generators. The module 36 controls inter alia the amplitude and frequency of the alternating magnetic fields generated by the generators.

[0052] The alternating magnetic fields interact with the coil 51 located in the probe 32, so as to generate an alternating electrode potential in the coil, and the electrode potential is received by the tracking module 36 as a signal. The module analyzes the received signal, together with the processing unit 42, and from the analysis, the position and orientation of the probe coil in the defined frame of reference can be determined.

[0053] Generally, the tracking by either or both of these systems can be visually rendered on the display 48, for example, by incorporating an icon representing the probe, and the path taken by the icon, into a map 49 of the heart 34. For the sake of clarity, in the following description, it is assumed that only the electromagnetic tracking system 23 is used, but the description can be adapted with the necessary changes to apply to cases in which both the system 23 and the system 21 are used, or only the system 21 is used.

[0054] Ablation module 39 includes a radio frequency (RF) generator that delivers RF power to a region of heart 34 selected by operator 22 in order to ablate the region. Operator 22 selects the region by positioning an ablation probe having an ablation electrode at the region. In some embodiments, probe 32 and one of electrodes 50, such as electrode 50B, can serve as the ablation probe and ablation electrode. Alternatively, a separate ablation probe and ablation electrode can be used for ablation provided by module 39.

[0055] ECG module 43 receives intracardiac (IC) ECG signals acquired by electrodes 50 when the electrodes are in contact with myocardial tissue of a chamber of heart 34. The ECG module analyzes the signals, along with PU 42, as described below, in order to find, among other things, local activation times (LATs) of the signals. The module typically formulates its measurements relative to a reference ECG signal, such as a reference ECG signal that can be provided by an electrode positioned in the coronary sinus of heart 34.

[0056] Figure 3 An example of IC ECG signals is shown in accordance with an embodiment of the present application. Signals 100 and 102 are acquired by electrodes 50 that are in contact with respective locations of myocardial tissue of a chamber of the heart, assumed by way of example herein to be an atrium. The signals are voltage versus time signals, and for simplicity, the axes of the signals are not shown in Figure 3 PU 42 and module 43 analyze each signal to determine one or more annotations for each of the signals. An annotation for a given location indicates the time LAT at which a conduction wave traversing the location in a beating heart, and is assumed herein to include an ordered pair of the signal, namely, the voltage V and the time t, of the signal.

[0057] As is known in the art, annotations for a given ECG signal can be set by different methods. For example, annotations for a ventricle can be selected to be at points on the QRS complex where the negative slope is steepest (i.e., where is most negative). For an atrium, annotations can be set at the maximum of the P wave of the signal, or alternatively, at the time where the P wave is most negative.

[0058] In the following description, it is assumed that the IC ECG signals are acquired from an atrium of the heart, and that the annotations of the acquired signals are at the times of the maximum of the P wave signal, unless otherwise stated. Cases in which the annotations of the P wave are at other locations, such as at the times where is most negative, are further noted below.

[0059] ​Signal 100 shows a signal with a single annotation 110 at the peak of the P wave, and such signals are also referred to as single-potential signals. Signals with a single annotation, such as signal 100, are typically generated by the heart 34 when beating at a sinus rhythm.

[0060] Signal 102 shows a signal with two annotations 114, 118, where the P wave has two peaks, and such a signal is called a dual-potential signal. Although a heart beating at a sinus rhythm can generate dual-potential signals, the presence of dual potentials can indicate, for example, arrhythmias, scar tissue, or ablated tissue.

[0061] As will be explained below, signals (such as Figure 3 The signals shown are used to generate an electroanatomical mapping of the heart 34 49.

[0062] Figure 4A This is a schematic diagram of an electroanatomical mapping 150 of a segment of the atria of a heart 34 according to one embodiment of the present invention. The mapping 150 is generated prior to the ablation of the myocardial tissue of the heart 34, and the mapping shows a portion of the electroanatomical mapping 49.

[0063] To generate mapping map 49, a three-dimensional (3D) mapping map of the heart chamber is first generated by moving the distal end 32 within the heart chamber and tracking and recording the orientation of the distal end using one of the tracking systems mentioned above. The recorded orientation includes a point cloud of orientations within the heart chamber and at the surface of the heart chamber, and the processor 40 can then analyze the point cloud using methods well known in the art to generate a 3D envelope surrounding the point cloud, which corresponds to the tissue surface of the atrium.

[0064] Once a 3D mapping has been generated, the surface of the atria can be characterized by acquiring and recording IC ECG signals from locations on the surface of the atria. Signal acquisition can be performed using electrodes 50 at the distal end 32, while simultaneously recording the position of the distal end and thus the position of the electrodes. This characterization can be performed as described above for... Figure 3 The signals (including notes on signals calculated by processor 40) are shown. According to the notes, the processor can initially assign LAT to the location where the IC ECG signal is acquired using methods well known in the art.

[0065] For a single-potential signal, LAT typically corresponds to the time of the single-potential annotation, i.e., the time of the P-wave maximum. Therefore, for signal 100, LAT is at the time of annotation 110. For a dual-potential signal, except as further described below, it is assumed that LAT corresponds to the time of the annotation with the maximum voltage. (If the annotation is based on the signal's...) If defined by this, then it can be assumed that LAT corresponds to the most negative the time of the annotation 114.

[0066] Thus, for the signal 102, the LAT is at the time of the annotation 114 if the annotation 114 has a greater voltage than the annotation 118. In the display of the annotation signal referred to further below, only the annotation selected for the LAT is typically superimposed on the signal. In Figure 3 In the display, the annotation 114 has been drawn as a solid circle to indicate that it is the annotation that has been selected for the LAT of the signal 102. Similarly, the annotation 110 has been drawn as a solid circle to indicate that it is the annotation that has been selected for the LAT of the signal 100.

[0067] Once the LAT value for a particular location has been determined, the processor can superimpose the measured value on a 3D map of the chamber, typically interpolated between two values, to produce an electroanatomical map. Different LAT values are typically shown as different colors in the maps 150 and 49, but for Figure 4A The regions 152, 154, 156 of the atrium in the map 160 are shown schematically as respective different types of shading 152L, 154L, 156L. The values of the LAT, typically in ms, can be shown as a legend for the map on the display 48, as shown schematically in Figure 4A

[0068] The operator 22 can evaluate the map 150 and, from that evaluation, can decide to ablate regions of the myocardial tissue, typically to correct a problem such as an arrhythmia occurring in the heart 34. To perform the ablation, the operator moves the distal end 32 so that the electrode 50 is at the selected location of the tissue. That movement is tracked by one of the tracking systems referred to above, and when the selected location is reached, that selected location can be recorded by the processor 40.

[0069] In addition to recording the selected location, once the operator has performed the ablation at that location, the location can be marked on the map 49, as described below with reference to Figure 4B

[0070] Figure 4B is a schematic view of a map 160 of a segment of the atrium of the heart 34 after ablation has been performed in accordance with an embodiment of the application. The map 160 is substantially similar to the map 150 except as described below, so that the locations of the regions 152, 154 and 156 are the same in both maps. The map 160 also includes marked locations 164 on the atrium that indicate locations at which ablation has been performed. By way of example, it is assumed that ablation has been performed on a line, but it will be appreciated that substantially any type of figure, including a dot region, can be marked on a map of the atrium in a similar manner to the locations 164.

[0071] ​​After the ablation shown in map 160, operator 22 can reacquire ICECG signals from the tissue to assess the efficacy of the ablation and update the map. The flowchart below shows the steps of the algorithm executed by processor 40 when the operator reacquires the signals. Figure 5 The flowchart below shows the steps of the algorithm executed by processor 40 when the operator reacquires the signals.

[0072] Figure 5 The flowchart below shows the steps of the algorithm executed by processor 40 according to an embodiment of the present application. In initial step 180, operator 22 assesses the electroanatomical map of the atrium of heart 34 (assumed herein to correspond to map 49), and as a result of this assessment, operator decides to ablate a region of the myocardial tissue of the atrium. The ablation region can comprise one or more separate points of the tissue; alternatively, the ablation region can be in the form of a line segment, similar to the form shown in map 160. Figure 4B The flowchart below shows the steps of the algorithm executed by processor 40 when the operator reacquires the signals.

[0073] In recording step 184, processor 40 records the location of the ablation performed, and also shows the location on map 49 displayed to the operator. This illustration typically comprises incorporating one or more icons into map 49.

[0074] In signal acquisition step 188, operator moves probe 32 to a location on the surface of the atrium, and electrodes 50 acquire a respective ECG signal at each of the locations. Processor 40 stores these signals, together with module 43. For each acquired ECG signal, the processor analyzes the signal to determine one or more annotations in the signal. The processor stores these annotations and the location of the signal providing them.

[0075] Unless otherwise stated, processor 40 iterates the following steps of the flowchart, as indicated by arrow 186, in order to analyze the acquired results. The iterative steps of the flowchart are shown as enclosed by dashed rectangle 190. In this iteration, processor analyzes each of the acquired ECG signals independently, as well as their stored annotations and locations, as described above. Figure 5

[0076] In first decision step 192, processor 40 checks whether the signal is a unipotential signal, i.e., whether the signal has a single annotation. If decision 192 returns positive, then in assignment step 194, processor assigns the time of the annotation as the LAT of the location. If decision 192 returns negative, then the flowchart proceeds to dual potential step 196.

[0077] In step 196, processor 40 determines that the analyzed signal is a dual potential signal.

[0078] ​In a second decision step 200, the processor 40 calculates the distance of the position of the signal from the respective ablation zone and assesses whether the position is close to the zone. That is, the processor calculates the distance of the position of the signal from all ablation zones and determines whether any of the distances is within a preset threshold distance. In one embodiment, the threshold distance is set to 10 mm.

[0079] If step 200 returns negative, i.e. the position of the signal is not within the preset threshold distance and thus remote from the ablation zone, then in a further assessment step 202, the processor assumes that the LAT of the position of the double potential corresponds to the annotation with the largest potential.

[0080] If step 200 returns positive, i.e. the position of the signal is within the preset threshold distance, then the position is close to at least one of the ablation zones. In this case, in an annotation assignment step 204, the processor assumes that the LAT of the position (valid annotation) is the annotation of the annotation closest to the neighboring position further away from the ablation zone. It is to be understood that the signal of the neighboring position can be a single potential signal or a double potential signal.

[0081] Once the processor 40 has completed the analysis of all ECG signals acquired in step 188, i.e. the processor has completed the iterative steps described above, the processor updates the map 49 in an update step 208. In this update step, the processor incorporates the valid annotations of steps 194, 202 and 204 into the map 49 by displaying the LAT values of the annotations in the map. By inspecting the updated map, the operator 22 is able to assess the efficacy of the ablation performed in the initial step 180 using the results generated as described above.

[0082] The above description assumes that the annotation of the P-wave is at the time of the maximum of the P-wave. The description can be changed with the necessary modifications to accommodate situations in which the annotation of the P-wave is at other orientations known in the art, such as at the time of the most negative of the P-wave.

[0083] For the sake of clarity, the above description assumes that the double potential signal is acquired from the atrium of the heart and analyzed according to the algorithm of Figure 5 The above description can be modified with the necessary changes to also apply to double potential signals generated in the ventricle of the heart. Thus, embodiments of the present application include the analysis of double potential signals generated in any chamber of the heart.

[0084] It is to be understood that the above-described embodiments are cited by way of example, and that the present application is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present application includes both combinations and sub-combinations of the various features described above, as well as variations and modifications thereof which would occur to persons of skill in the art upon reading the foregoing description and which are not disclosed in the prior art.

Claims

1. A method for electrophysiological assessment, comprising: Electrical signals were collected from myocardial tissue at multiple locations near the area of ​​ablated tissue within the heart chamber using a probe. The probe's path is traced within the mapping region containing the heart; Record the location of the ablated tissue and show the location on an electroanatomical mapping map; Store the electrical signal; A corresponding annotation is derived from the electrical signal, the annotation indicating the time it takes for a conduction wave in the myocardial tissue to cross the location during the heart's cycle; Store the annotation and acquire the location of the signal that provides the annotation; Identify a first location at a first distance from the region of the ablated tissue, wherein the electrical signal at the first location comprises a dual-potential signal having a first annotation and a second annotation at different corresponding times within the heart's cycle; A second location is identified near the first location at a second distance from the region of the ablated tissue, the second distance being greater than the first distance, and the electrical signal at the second location has a third annotation; Select the comment that is closest to the third comment between the first comment and the second comment as the valid comment for the first position; as well as The effective annotations are displayed on the electroanatomical mapping of the heart.

2. The method for electrophysiological assessment according to claim 1, wherein the electrical signal at the second location comprises a single-potential signal.

3. The method for electrophysiological assessment according to claim 1, wherein the electrical signal at the second location comprises a dual-potential signal.

4. The method of claim 1, wherein the chamber comprises the atrium of the heart.

5. The method of claim 1, wherein the chamber comprises the ventricle of the heart.

6. The method of claim 1, wherein the region of the ablated tissue comprises one or more separate points.

7. The method of claim 1, wherein the region of the ablated tissue comprises a line segment.

8. The method of claim 1, wherein displaying the effective annotation on the electroanatomical mapping includes deriving the local activation time (LAT) of the first location from the effective annotation and incorporating the LAT into the mapping.

9. The method of claim 1, wherein the first location is within a preset threshold distance from the region of the ablated tissue.

10. The method according to claim 9, wherein the preset threshold distance is 10 mm.

11. An apparatus for electrophysiological assessment, comprising: A display configured to present an electroanatomical mapping of the heart; A probe configured to acquire electrical signals from myocardial tissue at multiple locations near the area of ​​ablated tissue in the heart chamber; as well as Processor, the processor being configured to: The probe's path is traced within the mapping region containing the heart; Record the location of the ablated tissue and display the location on the electroanatomical mapping; Store the electrical signal; A corresponding annotation is derived from the electrical signal, the annotation indicating the time it takes for a conduction wave in the myocardial tissue to cross the location during the heart's cycle; Store the annotation and acquire the location of the signal that provides the annotation; Identify a first location at a first distance from the region of the ablated tissue, at which the electrical signal comprises a dual-potential signal having a first annotation and a second annotation at different corresponding times within the cardiac cycle. A second location is identified near the first location at a second distance from the region of the ablated tissue, the second distance being greater than the first distance, and the electrical signal at the second location has a third annotation. The comment closest to the third comment between the first and second comments is selected as the valid comment for the first position. The effective annotations are displayed on the electroanatomical mapping of the heart.

12. The device of claim 11, wherein the electrical signal at the second position comprises a single-potential signal.

13. The device of claim 11, wherein the electrical signal at the second position comprises a dual-potential signal.

14. The device of claim 11, wherein the chamber comprises the atrium of the heart.

15. The device of claim 11, wherein the chamber comprises the ventricle of the heart.

16. The device of claim 11, wherein the region of the ablated tissue comprises one or more separate points.

17. The device of claim 11, wherein the region of the ablated tissue comprises a line segment.

18. The device of claim 11, wherein displaying the effective annotation on the electroanatomical mapping includes deriving the local activation time (LAT) of the first location from the effective annotation and incorporating the LAT into the mapping.

19. The device of claim 11, wherein the first location is within a preset threshold distance from the region of the ablated tissue.

20. The device according to claim 19, wherein the preset threshold distance is 10 mm.

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